241066 01/13/15 CITY OF CARMEL, INDIANA VENDOR: 355133
ONE CIVIC SQUARE AUDREY B KOSTRZEWA CHECKAMOUNT: $*******294.32*
(9,
2592 TURNING LEAF LANE CHECK NUMBER: 241066
CARMEL, INDIANA 46032 CARMEL IN 46032 CHECK DATE: 01/13/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1125 4359000 REIMB 294.32 SPECIAL PROJECTS
Carmel * Clay
Parks&Recreation
Employee Expense Reimbursement Request
Date of Fund Account Account
Receipt Vendor listed on receipt # Line# Budget Description Amount Purpose of Expense
Staff gold medal photo
12/30/2014 Michael's 1125 4359000 Admin-Special Projects $ 294.32 custom framing
All receipts should be attached in the same order as listed above.
No sales tax will be reimbursed. TOTAL: $294.32
Employee Name(print) Audrey Kostrzewa
Address 2592 Turning Leaf Lane
Check
payable to: City, St,Zip Car I, IN 46032
Signature: i Approved by:
Date: 1'27:3'0/2014 Date: I CS/ "
T
Business Services Division,Revised 7-7-08
FILE: Shared\Forms\Business Services\Employee Exp Reim!)Request
Ii
I
ORDER CUSTOMER TAKEN BY ORDER DATE
71099 Carmel Clay Parks (317) 573-4021 Heidi 12/30/2014
--- � .�. Artwork S* Condition Mounts
t' 1:Art Item 19 5/8"x 15" OK Preservation
Description
List Price Sale Price`.
1 3/16 Acid Free Foam Core Backing $3.70 $1.48
B44
r
mx 21
�. '. '^ :. . •` f. X ..... _ � .._:......_. �__..__...___... .,, ria............ ... .. �_.�.. ..__._.,_. .�.....,_..t. ._ .._. .... _ _.....a_. ._.�
$7730 $30.92
4 ;F Medium Bronze
1 $293.30
$117.32
Pre3ervabon $2410 $9.64 "
k a. t toil
X. t• p ` ��. _.. ,_ i z
1 Masterpiece(24"x 30")
� .:�. ;.. �. c � �:• s� ._ -._-- -_ - _ i-: „- - ,� __. _ - - ---
/ a $138.00 $55.20
55 20
1. Preservation F'rt $7
1930 72.r
1V` Imperial Blue:B4836 __ $7730
$30.92
-.-__,__..m.-..
}- BronzeFillet`
„ .:.
..$10280 . $4L12;
_ •s?, r
NOTES-
SU$TOTAL $294.32
Total Size..27" x 22 3/8" QUANTITY
Your order is estimated to be completed on:
TAX $ 60
Tuesday, January 13, 2015 TOTA
L
You saved $441.48
We'll call you at(317) 573-4021 when it's ready for pickup.
Your framer Heidi is. available -to,.answer, any questions ,about your.
order, just call (317) 580-9200 or drop...by Michaels,Stores, Inc. :#99.51
at 14670 US Hwy 31 N Greyhound Plaza Carmel, IN 46032-1391.
Privacy Policy:
Michaels Stores,Inc.collects information about you when placing a framing order. This information may include your name,
mailing address,e-mail address,or phone number. It may also include any other personal or preference information that you
provide. You consent to Michaels Stores,Inc.and its related affiliates using this information to share special opportunities and
offers that may be of interest to you. You may withdraw your consent to use this information at any time.
Damage and Return Policy:
Michaels Stores,Inc.'s total liability for any loss or damage to a customer's property shall not exceed $250,and Michaels
Stores,Inc.shall have no liability for any property left over 60 days from today.All returns will be processed based upon the
original payment method.If the order is cancelled the same day,a full refund will be issued.Refunds on orders cancelled after
the original order date are limited to unprocessed custom components only.
I
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of bill to be properly itemized must show; kind of service,where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
355133 Kostrzewa, Audrey Terms
2592 Turning Leaf Lane Date Due
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO# Amount
12/30/14 Reimb Custom framing $294.32
Total $ 294.32
I hereby certify that the attached invoice(s),or bill(s)is(are)true and correct and I have audited same in accordance
with I C 5-11-10-1.6
' 20—
Clerk-Treasurer
i
Voucher No. Warrant No.
355133 Kostrzewa, Audrey I Allowed 20
2592 Turning Leaf Lane
Carmel, IN 46032
In Sum of$
$ 294.32
ON ACCOUNT OF APPROPRIATION FOR
101 -General Fund
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1125 Relmb 4359000 $ 294.32 1 hereby certify that the attached invoice(s), or
bill(s) is(are)true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
January 8, 2015
Signature
$ 294.32 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund